RATES

DIRECT DEBIT AUTHORITY

Assessment Number:
Return completed form to: Valuation Number:
Horowhenua District Council
HDC office only
Private Bag 4002, Name & Address:
Levin 5540 Finance Actioned
NAR Actioned

Please arrange weekly Tuesday or Thursday Name:

fortnightly Tuesday or Thursday
Ph ( )
monthly 15th of each month
quarterly payments from my account Email Address:

BANK DETAILS start date / /

D D M M Y Y Y Y

NAME: AUTHORITY TO ACCEPT

(Of Bank Account Holder) DIRECT DEBITS
(Not to operate as an
assignment or agreement)

BANK ACCOUNT FROM WHICH PAYMENTS TO BE MADE: AUTHORISATION CODE

0 2 2 5 1 5 8
Bank Branch No. Account Number Suffix
Please attach a deposit slip for your bank account

TO: THE BANK MANAGER,

BANK

BRANCH

TOWN/CITY

I/We authorise you until further notice in writing to debit my/our account with you all amounts which

HOROWHENUA DISTRICT COUNCIL

(hereinafter referred to as the Initiator)

the registered Initiator of the above Authorisation Code, may initiate by Direct Debit.

I/We acknowledge and accept that the bank accepts this authority only upon the conditions listed on the
reverse of this form.

INFORMATION TO APPEAR ON MY/OUR BANK STATEMENT (To be completed by the Initiator)

PAYER PARTICULARS PAYER CODE PAYER REFERENCE

YOUR SIGNATURE(S)

DATE

Approved Date: Recorded Checked BANK

2515 Received By: By: STAMP

10/13
 CONDITIONS OF THIS AUTHORITY TO ACCEPT DIRECT DEBITS

1. The Initiator:
(a) The initiator undertakes to give notice to the acceptor of the commencement date, frequency and amount at least 10
calendar days before the first direct debit is drawn (but no more than 2 calendar months). This notice will be provided
in writing (including by electronic means and SMS where the customer has provided prior written consent (by electronic
means including SMS) to communicate electronically). Where the direct debit system is used for the collection of payments
which are regular as to frequency, but variable as to amounts, the Initiator undertakes to provide the acceptor with a
schedule detailing the amount and each payment date. In the event of any subsequent change to the frequency or amount
of the direct debits, the initiator has agreed to give advance notice of at least 30 days before the change comes into effect.
This notice must be provided in writing (including by electronic means and SMS where the customer has provided prior
written consent (including by electronic means including SMS) to communicate electronically).
(b) May, upon the relationship which gave rise to this authority being terminated, give notice to the bank that no further
direct debits are to be initiated under the authority. Upon receipt of such notice the bank may terminate this authority
as to future payments by notice in writing to me/us.

2. The Customer may:

(a) At any time, terminate this authority as to future payments by giving notice of termination to the Bank and to the Initiator
by means agreed by the customer, bank and initiator.
(b) Stop payment of any direct debit to be initiated under this authority by the initiator by giving written notice to the bank
prior to the direct debit being paid by the bank.
(c) Where a variation to the amount agreed between the initiator and the customer from time to time to be direct debited
has been made without notice being given in terms of clause 1 (a) above, request the bank to reverse or alter any such
direct debit initiated by the initiator by debiting the amount of the reversal or alteration of a direct debit back to the
initiator through the initiator’s bank, PROVIDED such request is made not more than 120 days from the date when the
direct debit was debited to my/our account.
(d) From time to time request a variation to the amount or frequency. The Initiator agrees to send Notice of the net amount
of each Direct Debit no later than the day the Direct Debit is initiated. This notice will be provided in writing (including
by electronic means and SMS where the Customer has provided prior written consent (by electronic means including
SMS) to communicate electronically). The notice will include the following message:- "The amount of $....., was Direct
Debited to your Bank account on (initiating date)."

3. The Customer acknowledges that:

(a) This authority will remain in full force and effect in respect of all direct debits passed to my/our account in good faith
notwithstanding my/our death, bankruptcy or other revocation of this authority until actual notice of such event is
received by the bank.
(b) In any event this authority is subject to any arrangement now or hereafter existing between me/us and the bank in relation
to my/our account.
(c) Any dispute as to the correctness or validity of any amount debited to my/our account shall not be the concern of the
bank except in so far as the direct debit has not been paid in accordance with this authority. Any other disputes lie
between me/us and the initiator.
(d) Where the bank has used reasonable care and skill in acting in accordance with this authority, the bank accepts no
responsibility or liability in respect of: - the accuracy of information about direct debits on bank statements; and - any
variation between notices given by the initiator and the amounts of direct debits.
(e) The bank is not responsible for, or under any liability in respect of the initiator’s failure to give notice in accordance with
1 (a) nor for the non-receipt or late receipt of notice by me/us for any reason whatsoever. In any such situation the
dispute lies between me/us and the initiator.
(f) Notice given by the initiator in terms of clause 1 (a) to the debtor responsible for the payment shall be effective. Any
communication necessary because the debtor responsible for payment is a person other than me/us is a matter between
me/us and the debtor concerned.

4. The Bank may:

(a) In its absolute discretion conclusively determine the order of priority of payment by it of any monies pursuant to this or
any other authority, cheque or draft properly executed by me/us and given to or drawn on the bank.
(b) At any time terminate this authority as to future payments by notice in writing to me/us.
(c) Charge its current fees for this service in force from time to time.